RAILWAY OR RAILROAD SPINE.
If the presence of any gross lesion of the spinal cord or column can be detected, the case is at once lifted out of the category of so-called " railway spine," which latter must be regarded mainly, if not entirely, as a purely functional affection, and treated as such. The symptoms being altogether subjective and for the greater part referable to the cerebrum, the only rational line to he pursued in treatment is that clearly indicated in neurasthenia and shell-shock.
The greatest difficulty lies in the interpretation of the spinal pain or irritability which often tempts the physician to suspect malingering. This should be regarded as of the same nature as the pain in neuralgic, hysterical or neurasthenic conditions, and should be treated upon the principles which experience has proved to be valuable in these states. Though the spinal pain may he due, in the first instance, to some element of sprain in the muscles or fascia of the column, which has probably resolved itself, it is rendered permanent and real to the patient by his morbid introspection. caused by the memory of the fright experienced
in the accident, his dread of becoming paralysed, and the worry of pro tracted legal proceedings. Long-continued rest may only increase the hyperiesthesia and pain, hence, after the lapse of a rest cure period amply sufficient to meet the requirements of sprain, careful massage of the lumbar muscles and counter-irritation by blisters or the actual cautery applied to a few spots on both sides of the spinal column may he safely commenced. When the affection persists, it should be firmly treated as a case of traumatic neurasthenia by isolation, over-feeding and massage as carried out in the routine of the Weir Mitchell method. Unfortunately, in cases where legal proceedings are hanging over the patient's head, little improvement will follow any line of treatment till these are settled, after which, however, often without any treatment, the symptoms speedily vanish.